Perineal descent (PD) is a sign of connective tissue weakness of the pelvic floor, it can be measured mechanically or radiologically. Joint hypermobility can be a sign of a generalised connective tissue abnormality, there is an increased incidence of pelvic organ prolapse and faecal incontinence amongst patients with heritable connective tissues diseases. To explore the relevance of PD and the relationship between connective tissue abnormality and pelvic floor dysfunction five studies were performed.A new mechanical device for the measurement of PD, the laser commode, and the established mechanical device, the perineometer were compared to the current gold standard method of measurement, defaecating proctography in 68 subjects. The laser commode provided a mean overall PD measurement closer to that of proctography than the perineometer but the repeatability and reproducibility of the measurements were not accurate enough for the laser commode to be used either in the subsequent parts of this research project or in a clinical setting.Perineal descent was measured using proctography and joint hypermobility was measured using the Beighton score in 70 females with pelvic floor dysfunction. No correlation was found between PD and joint mobility.A review of 323 proctograms of females with pelvic floor dysfunction found an association between PD and rectal prolapse but no association between either PD and rectocele formation or PD and rectal intussusception. The Pelvic Floor Distress Inventory questionnaires of 133 females were correlated with their proctography findings. There was no association between PD and any of the clinical symptoms. Biopsies from the rectus sheath and pelvic floor fascia of 19 females with rectal prolapse were compared to those of 8 normal controls. There was no difference in collagen or elastin content between the groups but participant numbers were small. The pelvic floor fascia of the rectal prolapse group showed a higher percentage of well organised elastin than that of the control group but this did not reach statistical significance. Perineal descent does not appear to be a consistent indicator of severe pelvic floor connective tissue abnormality or injury. This study has furthered our understanding of perineal descent and the relationships between this finding and other pelvic floor disorders caused by connective tissue weakness. Future work will focus on further histological analysis of tissue from patients with rectal prolapse in combination with the use of more sensitive methods to establish the presence of an underlying connective tissue abnormality.

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Mitral valve prolapse (MVP) is thought to be one of the causes of unexplained cardiac arrest (UCA). However, previous studies are limited by the lack of a standardized evaluation of UCA and the absence of a control group to identify predictors of cardiac arrest. We performed a systematic review of studies that examined the yield UCA evaluation. We then reported the prevalence and characteristics of MVP patients from a multi-centre registry of patients with UCA. Lastly, we completed a protocol of a matched case-control study aiming at comparing echocardiographic features of MVP patients with and without cardiac arrest. As a result of these studies, we proposed a standardized algorithm for UCA evaluation and a definition for idiopathic ventricular fibrillation. Also, we reported the prevalence of MVP in patients with UCA and described few features that could potentially help distinguish patients with MVP at risk for cardiac arrest.

Zearalenone (ZEN) is an estrogenic mycotoxin produced by fungi in the genus Fusarium. Fusarium species commonly occur in cereal crops such as corn, wheat, barley, and rice which are used in swine feed. In addition to cereals, co-products of ethanol distillation, brewing, and baking are frequently re-purposed as swine feed. ZEN contamination has been related to severe reproductive issues including pelvic organ prolapse (POP), which describes the displacement of pelvic floor organs from their healthy anatomical positions. A recent rise in the rate of POP in sows highlights a need for more information surrounding the occurrence of ZEN in swine feed and the possible role of ZEN in POP. This research aims to understand the relationship between ZEN contamination in swine feed and swine reproductive health. The primary objectives of this work are to (1) characterize the stress relaxation behavior of vaginal tissue in the swine model, (2) determine how ZEN consumption effects the elasticity of pelvic support tissue. (3) determine where ZEN and a related metabolite accumulate in the swine reproductive tract, (4) evaluate the prevalence of ZEN and related Fusarium mycotoxins in swine feed and ingredients, and (5) track ZEN and related Fusarium mycotoxins throughout production of beer and brewers' spent grains (BSG). Results from this work can help stakeholders to mitigate mycotoxin contamination in swine feed, evaluate swine for ZEN toxicosis, and provide care for animals experiencing POP. / Doctor of Philosophy / Under certain conditions, some fungi produce harmful toxins (mycotoxins) that can compromise the health of humans and animals. Mycotoxin-producing fungi are common in cereal crops such as corn, wheat, and barley which may be fed to humans or animals. Swine are especially sensitive to mycotoxins, making feed composition important for animal welfare and profitability. Zearalenone (ZEN) is a mycotoxin that behaves like estrogen, a hormone frequently associated with female reproductive health. Pelvic organ prolapse (POP) is a condition, common in women, wherein organs in the pelvic floor such as the vagina, rectum, and uterus, descend from their healthy anatomical position. Swine herds are experiencing higher rates of POP, which may be related to ZEN contamination in feed. The overall goal of this research is to understand the relationship between mycotoxin contamination in feed and swine reproductive health. The specific objectives of this research are to (1) characterize the mechanical properties of vaginal tissue in swine, (2) characterize mechanical properties of pelvic support tissue associated with POP, in swine fed ZEN, (3) determine which reproductive tissues which accumulate ZEN in swine, (4) evaluate the prevalence of ZEN and related mycotoxins in swine feed, and (5) track ZEN and related mycotoxins throughout production of beer and brewers' spent grain, a co-product used in animal feed. This research can help animal producers develop strategies to mitigate mycotoxin contamination in feed and improve veterinary care.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

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Objectives Despite their growing prevalence, pelvic floor disorders (PFDs) remain undertreated and not well understood by patients, with treatment disparities noted in specific subgroups of women. The goal of the present study was to determine the basic understanding of PFDs of women in the southern Appalachian region of the United States, to determine factors that predict knowledge, and to explore the possible disparities in seeking access to care among women in this region who reported symptoms. Methods A survey of patient knowledge of PFDs, specifically urinary incontinence (UI) and pelvic organ prolapse (POP), was conducted in Johnson City, Tennessee, and involved 305 female patients from this city and the surrounding region. Results Almost half of the participants (43%) reported UI symptoms, with only 25% of these participants reporting treatment. A much smaller percentage (5%) reported POP symptoms, but 44% reported receiving treatment. Overall proficiency for UI knowledge was 54.4%, and 69.5% for POP knowledge. Higher UI knowledge was predicted (P < 0.05) by age younger than 60 years, annual income >$50,000, more than a high school education, and being married. UI knowledge was unrelated to the presence of UI symptoms, receipt of UI treatment, or having seen a urospecialist. Higher POP knowledge was predicted (P < 0.05) by annual income >$50,000, more than a high school education, and presence of POP symptoms. The only factor significantly predicting seeking treatment among women with UI symptoms was marital status. Conclusions Overall knowledge of both UI and POP was reasonably high in this population, suggesting appropriate self-education or education by providers in the region. The women most affected by UI, particularly those older than 60 years, were not well informed, and education by providers does not appear to specifically target women seeking treatment. We must continue to educate and further reduce the gap of knowledge and treatment regarding PFDs in southern Appalachia.